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Iliotibial Band Syndrome Acta Scientific Orthopaedics (ISSN: 2581-8635) Volume 2 Issue 9 September 2019 Clinical Review Iliotibial Band Syndrome Zeynep Demir* Department of Physiotherapist, Turkey *Corresponding Author: Zeynep Demir, Department of Physiotherapist, Turkey. Received: July 23, 2019; Published: August 16, 2019 - Function brous sheath that runs along the lateral thigh and serves as an im- The iliotibial band tract or IT band (ITB) is a longitudinal fi Proximal ITB function includes portant structure involved in lower extremity motion. The ITB is • Hip extension also sometimes known as Maissiat's band. The ITB spans the lower • Hip abduction extremity on its lateral aspect before inserting on Gerdy's tubercle • Lateral hip rotation on the proximal/lateral tibia. • Distally, ITB function depends on the position of the knee Proximally in the thigh, the ITB receives fascial contributions joint from the deep fascia of the thigh, gluteus maximus, and tensor • Active knee extensor fascia lata (TFL).The TFL is the deep investing fascia of the thigh, • 0 degrees/full extension to 20 to 30 degrees of flexion encompassing the muscles of the hip and lower extremity around • The ITB lies anterior to the lateral femoral epicondyle this region. Distally, the ITB becomes a distinct soft tissue layer of the lateral knee. • 20 to 30 degrees of flexion to full flexion ROM • ITB lies posterior relative to the lateral femoral • Active knee flexor There are multiple clinical conditions that can present second- epicondyle ary to a spectrum of ITB dysfunction and many of these manifest in physical laborers to recreational or high-level professional ath- Knee pain has been reported to limit mobility and impair qual- letes. Moreover, these conditions will vary depending on the spe- ity of life in 25% of adults. Iliotibial band syndrome (ITBS) is one based ITB conditions include external snapping hip syndrome, in US Marine Corps recruits during their training in 1975 and has cific anatomic location of the dysfunction. For example, proximally of the many different causes of lateral knee pain. It was first seen been diagnosed frequently in long distance runners, cyclists, ski- "snap") over the greater trochanter of the femur. Distally, ITB pa- ers and participants of hockey, basketball, and soccer since then. which occurs secondary to ITB friction as these fibers rub (or thology most commonly manifests as some form of lateral-based These activities all depend on rapid and prolonged cycling of the knee pain (commonly ITB syndrome, or ITBS). Athletes affected are often involved in sports heavily reliant on peak lower extrem- this cycling can cause the syndrome, as well as, discuss evaluation knee through flexion and extension. This article will discuss how ity function and performers, such as runners, skaters, or cyclists. and treatment modalities. Regardless of the ITB condition, most patients experience com- The iliotibial band (ITB) is the distal fascial continuation of the plete resolution of symptoms following nonoperative management tensor fascia lata, gluteus medius, and gluteal maximus. It traverses modalities alone. However, surgical consideration is a potential option for chronic, recurrent, or recalcitrant cases that continue of the lateral tibial plateau and partially to the supracondylar ridge superficial to the vastus lateralis and inserts on the Gerdy tubercle to persist despite exhausting of all nonoperative management op- of the lateral femur. There is also an anterior extension called the tions after several months. Citation: Zeynep Demir. “Iliotibial Band Syndrome". Acta Scientific Orthopaedics 2.9 (2019): 11-13. Iliotibial Band Syndrome 12 iliopatella band that connects the lateral patella and prevents me- process. The physical therapist should also focus on teaching prop- dial translation of the patella. The ITB functions as a knee extensor er ergonomics and posture while performing inciting activities. when the knee is less than 30 degrees of flexion but becomes a the i - postulated to acquire a more posterior position relative to the lat- Non-steroidal anti-inflammatories can help with diminishing knee flexor after exceeding 30 degrees of flexion. The ITB has been peutic, as well as diagnostic for ITBS by providing immediate and nflammation. Likewise, corticosteroid injections can be thera Clinicaleral femoral examination epicondyle withtesting increasing for ITB degrees dysfunction of flexion. is best prolonged pain relief. Shoe modification, foot orthosis, and sport elicited utilizing the Ober Test some cases. Most patients will have complete symptom relief and specific technique training can help prevent ITBS from returning in - able to return to activity within 6 to 8 weeks with nonoperative involved side in the lateral decubitus position. The symptomatic management alone. To perform the Ober test, have the patient lie on his or her un side should be facing upward (i.e., closest to the ceiling). Next, the The recommended progression back to activity starts with a wee examiner passively flexes the knee to about 90 degrees. The hip is weeks are focused on fast-paced running daily and avoid downhill k of running on alternating days on a flat surface. The following then brought passively into a flexed and abducted position. Next, running. After 3 to 4 weeks, the patient can gradually increase the hip brought into increasing levels of extension and adduction. A the examiner assesses the passive flexibility over the ITB with the distance and frequency. Introducing hills and cambered surfaces positive test entails pain, tightness, or clicking over the ITB. surface. If the patient relapses, then they will need to start their should only take place if there is no pain or symptoms on a flat activity progression over again and may require a period of rest beforehand. Surgical intervention is only for refractory cases despite non- operative management for more than 6 months. There are several surgical options including percutaneous or open ITB release, ITB lengthening with a Z-plasty, open ITB bursectomy, and arthroscop- ic ITB debridement. Furthermore, there are several different tech- niques described for the open ITB release including resecting a Figure 1 triangular portion of the distal posterior ITB band, resecting the 2 cm x 4 cm portion overlying the lateral femoral epicondyle and also making a V-shaped incision in the ITB.All of the different Treatment/Management techniques have demonstrated success, but there are limited com- parative studies to demonstrate superiority. ITB bursectomy is the ITBS is nonoperative management. The patient should be advised indicated option with the symptomatology of ITBS but no enhance- The first line treatment for the vast majority of patients with to refrain from the inciting activity until the pain has resolved. ment of the ITB on MRI. The procedure consists of excising the un- - turn to activity can commence as soon as the patient is pain-free demonstrated that the majority of patients who undergo open bur- Intermittent cryotherapy can help with acute flares. A gradual re derlying ITB bursa but leaving the ITB completely intact. One study with activity and palpation. Physical therapy focused on stretch- Minimal invasive techniques have been described to resect the lat- ing of the ITB and abduction strengthening can be very effective sectomy are overall completely or mostly satisfied with the results. at lengthening the ITB and reducing tension. Furthermore, manual eral synovial recess that connects the ITB to the lateral femur and therapy such myofascial release with a foam roller has been used innervated synovial fat. to break up adhesions and is an integral part of the rehabilitation Citation: Zeynep Demir. “Iliotibial Band Syndrome". Acta Scientific Orthopaedics 2.9 (2019): 11-13. Iliotibial Band Syndrome 13 Exercise prescription • Exercises to stretch the iliotibial band and related struc- tures. • Myofacial treatment is ideal in acute phase, when pain a - points in Biceps femoris, vastus lateralis, gluteus maxi- mus,nd inflammation and tensor fascia in the latae insertion muscles is felt.will Thebe addressed trigger by a myofascial treatment. • Exercises to strengthen the abductor muscles and stabi- lize the hip. • Hip/knee coordination and running/cycling style modi- ication through the increase of neuromuscular control of gait [1-4]. f Bibliography 1. https://www.archives-pmr.org/article/S0003- 9993(06)00531-4/pdf 2. Andrew Hadeed and David C Tapscott. “Iliotibial Band Fric- tion Syndrome” (2019). 3. Scott Hyland and Matthew Varacallo. “Anatomy, Bony Pelvis and Lower Limb, Iliotibial Band (Tract)” (2019). 4. https://www.physio-pedia.com/Iliotibial_Band_Syndrome Volume 2 Issue 9 September 2019 © All rights are reserved by Zeynep Demir. Citation: Zeynep Demir. “Iliotibial Band Syndrome". Acta Scientific Orthopaedics 2.9 (2019): 11-13..
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